Lease Credit App | Platinum Copiers

Platinum Copier Solutions Sales Representative

Company Legal Name(Required)

Please include DBA (Doing Business As) if applicable.

Main Phone Number(Required)

Tax ID Number

Not required now, but will be required on the lease documents. Find this easily on your company's W9 form.

Lease Signer Contact Information(Required)

First Last Email Title

Billing Contact(Required)

First or Department Last Email Phone

Meter Reading & General Contact(Required)

First Last Email Phone

IT Contact

Location First Last Email Phone

Ship-To Address(Required)

Street Address Address Line 2 City State ZIP Code

Bill-To Address(Required)

Same as Ship-To Address

Street Address Address Line 2 City State ZIP Code

Length of Time in Business(Required)

*For new businesses additional information for a principal / owner may be required for a personal guarantee on the lease.

Principal / Owner Information

First Last Social Security Number

Most likely required for businesses with less than 1 year of operating time. If you are not comfortable sharing these details via this secure web form, contact your sales representative directly.

Principal / Owner Home Address

Street Address Address Line 2 City State ZIP Code

Comments/Questions